A57-year-old man was admitted to our University Hospital with a diagnosis of ischemic stroke. He had no antecedent illnesses. He had been a shepherd for 10 years. Physical examination disclosed an aphasic man with complete right hemiparesis and no other remarkable sign. Chest radiograph showed the left heart border to be lobulated and partially calcified (Figure 1⇓). Cranial CT disclosed hypodense areas in the right cerebellar hemisphere and the left temporoparietal and left frontal regions. An ECG revealed T-wave inversion in leads V4 through V6. Cardiac MRI revealed an infiltrated cystic mass in the anteroapical region of the left ventricle (Figure 2⇓), in accordance with the transesophageal echocardiogram (Figure 3⇓). Cardiac catheterization and angiocardiography revealed normal coronary arteries and a calcified cystic mass in the anteroapical wall (Figure 4⇓). With a diagnosis of echinococcosis, the patient was referred to cardiac surgery for resection of the mass. At operation, a multicystic mass involved the anteroapical wall of the left ventricle, with adhesions to the pericardium (Figure 5⇓). The endocardial aspect was protruding inside the cavity, but it was smooth. The postoperative period was uneventful. Analysis of the resected specimen revealed multiple hydatid cysts with live scolices of Echinococcus granulosus. After therapy with albendazol (5 cycles of 30 days [10 mg · kg−1 · d−1] with rest periods of 2 weeks between the cycles), the patient has remained well.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
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